Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain.
Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, 38010, Santa Cruz de Tenerife, Spain.
Neurol Sci. 2021 Sep;42(9):3631-3636. doi: 10.1007/s10072-021-05048-x. Epub 2021 Jan 12.
There is scarce data on B cell lymphoma 2 (Bcl2), a member of the Bcl-2 family of antiapoptotic molecules of the intrinsic apoptosis pathway, in patients with spontaneous intracerebral hemorrhage (SIH). In one study, higher serum Bcl2 levels were found in patients with SIH than in healthy subjects. Thus, the objective of our study was to compare serum Bcl2 levels in surviving and non-surviving SIH patients.
Patients with severe supratentorial SIH (defined as Glasgow Coma Scale < 9) admitted from the Intensive Care Units of five Spanish hospitals were included in this observational and prospective study. Serum levels of Bcl2L were determined at the time of diagnosis. Thirty-day mortality was the end-point study.
Non-surviving (n = 38) compared to surviving patients (n = 41) had higher intracerebral hemorrhage (ICH) score (p = 0.001), midline shift (p = 0.003), and serum Bcl2 levels (p < 0.001). In addition, non-surviving compared to surviving patients had lower early hematoma evacuation rate (p = 0.03). We found 77% area under curve in mortality prediction for serum Bcl2 levels (95% CI = 0.66-88%; p < 0.001). Patients showing serum Bcl2 levels > 16.5 ng/mL had higher risk of death according to analysis of Kaplan-Meier (HR = 5.2; 95% CI = 2.5-10.6; p < 0.001). An association, after control for ICH score, midline shift, and early hematoma evacuation, was found between serum Bcl2 levels and 30-day mortality (OR = 1.090; 95% CI = 1.030-1.154; p = 0.003) in the multiple logistic regression.
As far as we know, our study is the first one reporting higher serum Bcl2 levels in non-surviving than in surviving SIH patients and the association between serum Bcl2 levels and SIH mortality.
B 细胞淋巴瘤 2（Bcl2）是内在凋亡途径中 Bcl-2 家族的抗凋亡分子之一，关于其在自发性脑出血（ICH）患者中的数据十分匮乏。有研究表明，ICH 患者的血清 Bcl2 水平高于健康人群。因此，本研究旨在比较存活和非存活 ICH 患者的血清 Bcl2 水平。
纳入来自西班牙五家医院重症监护病房的严重幕上 ICH（格拉斯哥昏迷量表评分＜9）患者进行此项观察性前瞻性研究。在诊断时测定血清 Bcl2L 水平。30 天死亡率为研究终点。
与存活患者（n=41）相比，非存活患者（n=38）的颅内出血评分（ICH 评分）更高（p=0.001），中线移位更大（p=0.003），血清 Bcl2 水平更高（p＜0.001）。此外，非存活患者较存活患者的早期血肿清除率更低（p=0.03）。我们发现血清 Bcl2 水平对死亡率的预测有 77%的曲线下面积（95%置信区间=0.66-88%；p＜0.001）。根据 Kaplan-Meier 分析，血清 Bcl2 水平＞16.5ng/mL 的患者死亡风险更高（HR=5.2；95%置信区间=2.5-10.6；p＜0.001）。在校正 ICH 评分、中线移位和早期血肿清除后，血清 Bcl2 水平与 30 天死亡率之间存在关联（OR=1.090；95%置信区间=1.030-1.154；p=0.003），这在多变量逻辑回归中得到证实。
据我们所知，本研究首次报道非存活 ICH 患者的血清 Bcl2 水平高于存活患者，并且发现血清 Bcl2 水平与 ICH 死亡率之间存在关联。
